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April 09, 2015

(++++) OUR BODIES, THEMSELVES

Body of Truth: How Science,
History and Culture Drive Our Obsession with Weight—and What We Can Do about
It. By Harriet Brown. Da Capo. $25.99.

Argumentative and
determinedly one-sided, Harriet Brown’s Body
of Truth is a highly useful corrective to the veritable flood of books
warning people to watch their weight, change their weight, balance their
weight, and pay constant attention to their weight in order to be healthy,
fulfilled and happy. It is a book that will surely be read with relief, if not
glee, by the legions of people who are weight-focused – including those that
are, yes, obsessed – but who are nevertheless unhappy in their own skin and
unconvinced that all the dieting, careful food choices, and constant attention
to weight have done them any good.

Brown’s argument here comes
down to a single statement: “As with pretty much every aspect of the research
on weight and health, there’s no absolute consensus, and there’s a lot we still
don’t know.” This is quite true, in weight-related research as in other aspects
of science, but if this is the kernel of Brown’s argument, it is not the
entirety of it. She points out that some research studies (she offers copious
citations: the book has just over 200 pages of text plus nearly 70 of notes,
references and index entries) find a certain level of correlation of health issues with a person’s weight but that this
does not establish causation. And
this too is quite true – indeed, the vast majority of contemporary medical/scientific
research turns up associations between one thing and another without showing,
or being able to show, that Thing A is the cause of Thing B. This inability to
establish causation is inherent in study design and directly related both to
longitudinal issues (how long it takes to do convincing studies showing
causation) and to medical/scientific ethics. But dissecting research is not
Brown’s purpose here. Her concern is the harm that societal weight obsession
demonstrably does, on an anecdotal basis, to people who get pulled into the
orbit of a social environment and medical establishment that focus, often
without strong scientific justification, on the importance of weight loss.

The concerns expressed by
Brown, a Syracuse University associate professor of magazine journalism, arise
from personal circumstances, including 10 years she spent in therapy to try to
deal with her own weight-related issues and a serious condition that affected
her daughter: “A sixth-grade ‘wellness’ class kicked off both her anxiety about
eating and her interest in health. Though her weight was normal, she started to
worry about being fat. She cut out desserts, telling us she’d learned that
sugar was unhealthy. Over the next six months or so, her restricting took on a
life of its own, and eventually turned into full-blown anorexia that nearly
killed her.” This situation, which Brown wrote about in a previous book, is
certainly intense and frightening enough to send someone with research skills
and writing ability into the world and the scientific literature in search of
understanding and clarity.

It is also, however, a
recipe for confirmation bias – a flaw of which Brown is as guilty as are
doctors who use anecdotal reports of weight-related health issues to make
generalized statements about the way things “must” be for people in general.
Confirmation bias is simply the tendency to give greater significance to
matters that support your thesis while ignoring or simply not seeing ones that
counter it. Doctors and scientists are as prone to this as anyone else,
although the scientific method is a bulwark against it when properly understood
and correctly applied. It is inevitable that Brown, convinced that weight focus
is vastly overdone and done on the basis of insufficient data – and that the
focus does tremendous harm to people such as her daughter and herself – will
find material, scientific and anecdotal, to back up her assertions. The
anecdotal items, sprinkled throughout the book, will connect most strongly with
readers, but anecdotes are not research: they are pieces of information that
may lead to research. So it is possible to accept as truth that every single
quotation and life history in Body of
Truth shows that some individuals are and have been significantly harmed
through weight obsession without needing to accept the notion that weight
obsession is provably a bad thing.

Brown does search for such
proof, but does not find it; it does not exist, any more than does certainty
about the relationship between weight and disease. However, Brown does turn up
some intriguing material. For example, she finds some convincing research that
indicates that each individual has a normal body-weight range beyond which it
is difficult to go, and that artificial goals set through Body Mass Index and
other measurements are simply inappropriate. She also finds studies indicating
that it is lack of exercise, not weight, that is the primary culprit in
conditions usually thought of as weight-related, such as cardiovascular disease.
And she comes back, again and again, to a life-changing question that her
therapist posed to her: “What if you were OK with your body the way it is right
now?”

This is, in fact, one heck
of a good question, and its impact grows the longer one contemplates it. Body of Truth is essentially an extended
argument that it is OK to be OK with the body you have. It makes its point too
intensely at times: early on, describing weight obsession as an epidemic, Brown
writes, “You’d be hard-pressed to find a twenty-first-century culture that didn’t struggle with it,” a statement
that ignores India, Bangladesh, central Asia and most of Africa. And Brown goes
off track when she shows an unfortunately all-too-typical journalistic
anti-business bias, stating that the fact that much research into obesity and
other areas of health is funded by businesses that make products in those
fields indicates skewed study design and even skewed results. Brown worriedly
notes that “pharmaceutical companies fund about 70 percent of the [drug] research
in the United States; the NIH [National Institutes of Health] funds the other
30 percent.” So 70% of research is tainted, or should not be believed? Should
research funding be cut 70% to get rid of the involvement of corporations and
their affiliated research foundations? Or should that 70% of funding come
from…where, exactly? The NIH, which means the government, which means higher
taxes and trusting future health discoveries to government employees? This
kneejerk dislike of research funding methods is among the book’s weakest
elements, indicating a political agenda rather than a carefully thought-through
attempt to make an important point about how much we know, and do not know,
about the relationship between weight and health.

That point is nevertheless
worth making: there is not settled
scientific or medical research (no matter how funded) indicating a causative
relationship between weight and a multiplicity of diseases, and there is evidence that societal and individual
weight obsession can do and does do more harm than good – certainly for some
individuals, and arguably for society as a whole. Body of Truth is unlikely to change Americans’ (or American
doctors’ and nutritionists’) attitudes toward food, but it deserves credit not
only for trying but also for offering an alternative to the way the
weight-obsessed currently regard what they eat. Taking a cue from dietitian and
eating specialist Ellyn Satter, Brown argues for “competent eating,” which
includes a positive attitude toward eating and food, tuning in to one’s body’s
hunger and fulfillment cues, being able to eat a variety of foods, and trusting
oneself to manage food well. The last of these will be the most difficult for
the weight-obsessed to, so to speak, swallow, but it is arguably the most
important: trusting oneself around food, rather than trusting doctors or
nutritionists or weight-loss programs or even one’s own family and friends,
requires having a stronger sense of self and more inner fortitude than many
people have. As Brown writes, “So long as we consistently look to other people
and the culture to tell us we’re OK, we’re attractive, we belong, even those of
us who are the most beautiful and self-confident will struggle. I think we have
to learn not to look outward for that stamp of beauty approval.” This is good
therapy-speak, but it is scarcely a simple (or even moderately complex) matter;
and it is certainly not the sort of foundational attitudinal change that Body of Truth or any other book can
provide. But at least Brown’s work can be a good first step toward it.